Theological and Clinical Wisdom for Responding to Pain That Will Not Go Away Farr Curlin, MD, Josiah C. Trent Professor of Medical Humanities in the Trent Center for Bioethics, Humanities and History of Medicine, and Co-Director of the Theology, Medicine and Culture Initiative at Duke Divinity School

In light of the opioid epidemic, how should Christian clinicians, pastors, and laypeople respond to those who suffer pain, and particularly those who suffer pain that will not go away? Clinicians are in a tough spot. For decades they have been encouraged to treat patients’ pain as a matter of compassion and of justice. In a seminal essay, “The Relief of Suffering,” physician and medical ethicist Eric Cassell wrote, “[A]dequate pain relief is a hallmark of good care in the sick patient. The proper dose of analgesic is that which relieves pain, something to which only the patient can testify.” Unfortunately, Cassell’s prescription leads to increased use of and addiction to opioids, forcing the medical community today to reconsider the widely accepted bioethical injunction that pain should be treated until the patient says it is relieved. How should Christians in particular think about the use of medicine to relieve chronic pain?

In this essay, I propose that wise responses to pain, and particularly chronic pain, will take their bearings from the moral resources internal to the practice of medicine, properly understood, and also from how early Christians made sense of the place of both medicine and suffering in a faithful life. With respect to the resources internal to medicine, Cassell himself encouraged clinicians to keep their eye on the integrity of the patient in the multiple dimensions of the patient’s personhood. In so doing physicians can prescribe medications (including opioids) with an eye to how these medications preserve or threaten the integrity of the patient’s life as a whole. Similarly, Cassell’s focus on the one who is sick reflects medicine’s constitutive orientation not toward the relief of suffering, but toward the patient’s health—a genuine good that is a feature of our creatureliness. Health provides a criterion to help patients and clinicians resist the overuse of narcotics for pain syndromes for which the category of sickness less clearly applies. ​Early Christians, and the Greek patristics in particular, were keen to both appreciate what medicine offered the faithful as a remedy for the deficiencies of our fallen nature, and also to practice patience with those deficiencies, and to resist putting one’s hope in medicine to fully relieve them. In this essay, I will turn to the writings of several patristics to contrast their theology with modern assumptions about the evil of suffering and the centrality of our obligation to relieve it. In light of that theology, and in view of the powers and limits of a medicine oriented to the patient’s health (rather than to minimizing suffering as the patient perceives it), I will offer several heuristics for wise and faithful responses to chronic pain.